Book Reviews

on September 17-19, 1979. The following agenda is planned: (1) surgical treatment of hydrocephalus in children, (2) diagnosis and surgical treatment of cervical myelopathy, and (3) open discussion (forum of young neurosurgeons). This meeting is also planned as a joint meeting with the Italian colleagues who invited us to Taormina in 1974. Meetings and Congresses. Meetings of Particular Importance to our Society:


By John
Ring, Member of the Royal College of Surgeons in London, and of the Medical Societies of London and Paris. Svo. pp. 208. Callow. 1811. In the composition of this book, Mr. Ring has displayed considerable ingenuity and industry. Ife does not pretend to throw any new light upon this disease, to present any new theory, nor enforce any new mode of practice. His researches, however, convince us, that much may be effected towards the cure of the complaint; and demonstrate the advantage of inquiring into the opinions and practice of our predecessors Ring on the Gout. 479 decessors in the healing art* From neglecting the study of medical writers, we are apt to consider as novelties, facts "which are coeval with the tather of physic himself; and authors have claimed originality, wheh (hey have only had the merit of repealing what, they had read.
Mr. Ring,'therefore, in our estimation, has performed an useful task in briefly staling the opinions of the most famed "Writers, ancient and modern, on the subject ol Gout. From, which statement it appears manifest, that, though many of the crude notions respecting the*nature and cause of the com-, plaint have been abandoned, the mode of treating it has undergone little improvement. Indeed, were we fairly to balance the question, we think, the stimulating plan of'some, and the repellent, system of others among the moderns, would so muchoverweigh the worst practice of the ancients which could be adduced, that we should be compelled to yield them the palm, ll is also ph asing to remark, how nearly the most respectable and eminent physicians, of whatever age or school, coincide in their view of treatment and cure.

>.
Hippocrates advised purging, drinking whey and asses milk, and copious affusion of cold water to the parts affected.
" Celsus recommends bleeding immediately on the attack of the gout, and says if sometimes removes the fit for a year, and sometimes for life He also recommends temperance, frictions, warm and cold affusions, and occasional evacuations.
When the swelling and inflammation are considerable, he recommends cold bathing, but gives a caution against keeping the limb in water long." Galen prescribed bleeding, purging, and repellents. Ccelius Aurelianus clysters, cupping, or leeches; and after the |i', bathing, exercise, abstinence. Oribasiusdirected bleeding, purging, and friction with salt and oil at the decline ofthe disorder.
JUng on the Gout.

481
the Care of Gout, which seem to result from considerable experience, and merit attention. " The gput is an inflammatory disease, and, like Qther inflammatorydiseases, cm only be cured by the cooling or antiphlogistic plan ; yet as it seldom or nerer occurs but in habits previously debilitated, either by indolence, intemperance, vehement mental affections, or unusual exposure to cold, it requires great judgment and extensive knowledge of the healing art, to carry this plan into execution. " In plethoric habits, and in others when the symptomatic fever is violent, bleeding in the arm is necessary. Local bleeding is necessary in some cases, and advisable in all. This is best done by leeches ; but sn some instances, where leecijes could not be procured, great relief has been derived from opening a vein in the vicinity of the part affected, or from simple scarification. / " Emetics should either not be prescribed in a paroxysm of the gout, 6i prescribed with great caution. They are particularly dangerous when .there is any sign of fulness of blood, or an inflammation of the stomach, which is indicated by sickness, with pain in that organ. " Cathartics are in general useful in the gout, and have furnished the principal materials of the regular and empirical remedies, for that and other inflammatory disorders in all ages. They should never be omitted when constipation prevails; nor when the heat of the skin, and hardness of the pulse, indicate that the phlogistic diathesis runs high. Sudorifics also are sometimes of service in arthritic, as well as in rheumatic affections. They should not be selected from the stimulant* aromatickind, nor given in a large dose, to bring on a profuse sweat, but administered in sach a manner as only to promote a gentle perspiration. " The best emetics are the preparations of antimony and ipecacuanha ; the best cathartics are, manna, salts, rhubarb, magnesia, calomel, scammony, and senna. The best sudorifics are, antimonials, or ipecacuanha, in small doses, volatile salines, tepid diluting liquors, and temperate warmth. ; /.
? " Opiates, though endowed with an anodyne and sudorific property, should never be given till after the remission of the inflammatory symptoms, unless in conjunction with a*cathartic. " Strict attention must be paid to regimen in the gout; especially during the paroxysm of the disorder. The patient should then abstain from all sorts' of animal food, aromatics, and fermented liquors, and live on arrow-root, water-gruel, panada, sago, or other farinaceous iood. He should drink some mild diluting beverage, such aa barley-water, toast and water, or tea.
. ? > " During the increase and height of the fit, he should keep, his bed, or at least remain at rest, and in a recumbent posture; but when a crisis has taken place, and pain, and other symptoms of inflammation abate, advantage may be derived from a slight motion of the joint, or from gentle friction, which may be gradually increased. .. ? " Even when the patient is in a state of convalescence, and his appetite keen, abstinence, or at least temperance, should be enjoined, and he ought to be very cautious how he indulges himself in the luxuries of the table, otherwise a relapse may take place. Bitters, and other provoca-, JR2 lives 482 Critical Analysis.
tives of the appetite, should either be totally interdicted, or cautiously prescribed. The best tonic, in general, in such cases, is moderate exercise; which, if regularly performed, steadily persevered in, and accompanied with temperance, will seldom fail to restore health,-and invi- wine, bark, in large doses, and blisters along the spine. "When he perceived that the wine and bark began to lose their action, he added oil of amber*.
In a subsequent memoir, he appears to piace greater confidence in opium, if given in considerable doses. When a person has the first indications oi tetanos, the Professor recommends an emetic, a strong dose of laudanum, the warm bath and cinchona. If there is a wound, it is to be laid open, and inflammation and suppuration to be excited. By these means he has succeeded more than an hundred times in preventing the disease.
He has also seen good effects produced by cold baths and cold affusion, and in some cases advises the patient to be wrapped in wet sheets.
Many cases are .recorded in various journals in which mercury proved beneficial; but it is extremely difficult to obtain the-mercurial action in sufficient time.
In some instances benefit was derived from the Use of polygala senega, in others of tincture of cantharides, and in some of tobacco glysters. ?Thk subject of this case wlien a child was extremely delicate ; the, period of his infancy was passed in .sickness, and he was reared with difficulty. Between three and font yea re of age he had a low nervous fever ; at eight arid a half, hooping cough, which was severe and obstinate. At nine and a half he was attacked with putrid fever, which continued fifteen days. Six months afterwards, in the beginning of autumn, he complained of violent pains in the head, not continual or regularly periodic, but very frequent.
Various remedies, chiefly anti-scorbutics, were prescribed, and the symptoms yielded. Three weeks afterwards'they recurred, and at the commencement of the autumn became insupportable. Vapour baths were ordered, and continued once or twice a day for three months. The cure appeared radical tili the autumn, when the,, child again experienced pain of the head less violent, but attended with a sense of "Weight ; these again yielded to the vapour-bath.
In the summer of 1805, being in his fourteenth year, he entered as a cadet in the navy at Petersburgh. He embarked and continued on board ship two months without experiencing any inconvenience. , in the month of October he was attacked with colic, and continued vomiting, not only of alimentary but of glareous matter ; he was not intemperate, and did not suffer from sickness whilst at sea. in the night of the 18th?19th of September, 1806, three Weeks after returning from a cruize at sea, during which he had suffered no inconvenience, commenced thesomnambulism tind other affections about to be described. The patient was found in an insensible state at a distance from his chamber. Blisters were applied. On recovering his senses, lie had no recollection of Iniving left his bed or his chamber. He swooned twice in twenty-four hours, his mouth being wide-open, and his limbs stiff as if dead ; the pulse Continued beating. At intervals he was seized with trembling and signs of fear. Sometimes during the paroxysm lie got out of bed, and if he had not been supported would have fallen down. The disease increased daily. Occasionally the paroxysms were characterized by an appearance of choaking nr or strangling, from which the patient relieved himself by thrusting his fingers as far as the base of the tongue, and provoking vomiting of glareous matter ; at other times, lie was affected with terrible convulsions, alternating with fright and fury without any evident cause, striking and biting himself.
At this period a physician was called in and medicines were employed. On the 17th of October, the 30th day of the disease, lie was suddenly depriyed of the use of his legs, after a slight paroxysm which had only continued a quarter of an hour, though the former ones had been longer. For eighteen days he was obliged to use crutches, except during the paroxysms, when the legs resumed their power and participated in the violent action of the whole body.
The fourth of November, fhe seventeenth day of being in this slate, the patient could not support himself and wab obliged to remain in bed ; this weakness continued three days, when he resumed his crutches, arid seven days afterwards the legs regained their power and motion. As this alteration took place the paroxysms put on the tertian type ; and their dura-. tion was habitually from an hour to an hour and a half. * Beginning of the Somnambulism.?Elixir of vitriol had been substituted for-the most powerful antispasmodics, bark, and vermifuges ; and in eight days the trembling, signs of fright, choakings, stranglings, paroxysms of rage, in which the patient struck and bit, were subdued, and a calui somnambulism was established.
During a short interval when the young man possessed his reason, he was suddenly surprized with a trembling in his hands, and a sleep which scarcely endured a minute and a half. Immediately afterwards he employed himself in mathematics, and reading some books of amusement. These symptoms recurred at the decline of every paroxysm till (he termination of the disease.
The patient continued in this state, with some slight variations, from the 26th of November, 1S06, till the 12th of March, 1808.
The author,of the memoir has arranged the different appearances of the somnambulism under sixteen periods, of these we shall select those which are interesting and explanatory of the disease.
Type and variation in the Course of the Disease. * \ From, its commencement the disease manifested itself by paroxysms which continued every day an hour or an hour and a half. The 26th of November of the same year, 1806, the paroxysm, Case of Somnambulism. 485 roxysm recurred every second day, between eight and nine o'clock in the evening, and continued in this type till the JO'th of March, 1807. At this epoch it varied : sometimes two paroxysms occurring in one day, one in the morning-, another in the evening. This continued till the 7th of April, during which time, there were only two days with one paroxysm ; but whether double or single, they preserved the tertian intermittent character.
These symptoms continued with greater or less urgency, with longer or shorter intervals of relief, till March, 180S, when they entirely ceased. Between the paroxysms, when^ they took the type of tertian intermittent, the young man was in full possession of his faculties, studied mathematics, history, and belles lettres, with close attention, and diverted himself with conversatipn and amusements agreeable to his age. lie was fond of tea and coftee, preferred beef to any other meat, disliked wine and liquors, and ^vas gentle in his manners.. y During the paroxysm,, if, which was frequently the case, he was occupied in mathematical labours, his operations were rapid and accurate. The logarilhmal calculations in which he was engaged demanded strict attention, and a long series of -combinations ; hence he had daily, to resolve new problems for the first time, which could not be attributed to a mechanical reproduction of mempry. Before he inserted the solution in his book, he tried it on a slate, and if he found it incorrect, began it over again. When he had copied this solution, he collected his papers, instruments, &c.-and placed them in order. It seemed as if the symptoms, which usually terminated the paroxysm, waited for this moment, for they immediately evinced themselves and the fit ended.
If the paroxysm occurred whilst lie was reading, he resumed his book after the fit, and continued the subject where he had left oft', though he had not marked the place. He expressed his wishes by signs or in writing, and sometimes he spoke, and even kept up a continued and rational conversation ; thus after having read a portion ofjhe Iliad, he con-Versed upon it by question and answer. < In all circumstances his eyes were open, and his look was natural; he saw objects but did not always rccognize them.
Thus, having received a letter from his father who promised to come to him in the spring, he stood musing for half an hour at a window which looked into the court-yard, without making any reply to the questions which were addressed to him. He then ran hastily into his chamber, took his bed-furniture, cov verlets, 4SG Critical Analysis. verlets, sheets, matrass, and pillows, arranged them in the saloon ; placed the table beside the bed, and covered it with every thing'necessary for a repast, "which he got from the buffet. Hitherto tlie organ of sight appeared to be faithful ; bat though his nurse was close by him, and a relation who iiad never quitted him, he Complained that from the moment his father was expected, every body had irone out, and that lie was left alone. He returned to the window, reperused his father's letter, looked for some time stedfastly on the courtyard, and withdrew to his chamber, whither he was followed by his relation and the nurse. He remained & little while without seeming to observe them, at length he recognized his relation, and thanked him for returning so a propos. Some timeafterwards he saw his nurse, who was at a little distance, and embraced her to express how glad he was to see her come back again to the house. He returned to the casement, and feeling that the paroxysm was near its termination, threw himself on the bed. Convulsive shakingof the hands and fee*, and a short sleep came on, and lie presently arose, asked the hour, and ordered.tea to be brought.
The organ of hearing did not appear to be affected ; only when reading low, being requested to read louder that he might be heard ;? he remained stiipified, and had a violent Convulsion : when this was over he asked for paper ; sonic was presented him on which was written the request to read louder, lie no sooner perceived tue word 'oiidcr than he was attacked Avith fresh convulsions. Upon offering him another piece ot paper, he wrote quietly.
The sense of touch-did not suffer. The digestive organs underwent no alteration.
His appetite indeed was small, But digestion was well .performed, and the bowels were open, but the stools were slimy. The pulse was usually at SO or 82. ? In some paroxysms he appeared terror-struck, in some he was very furious : and occasionally lie was in a state of stupor, motionless, his limbs stiff. Almost always lie complained of acute general pains, more severe in the legs and head than in other parts ; these lie had experienced for several years.
The complaint was-considered by the physicians as decidedly nervous, Complicated according to some of them with worms, because vhe patient had voided*some during the fever when he was nine years and a half old. One practitioner. in high repute,1 not only considered the affection as nervous, but alleged that it depended upon a scrofulous habit. v In consequence of these opinions, the most powerful antispasmodics, bitters, tonics, vermifuges, and vapour-baths / Were 'Were proscribed ; and they several times afforded so much'relief that the cure was thought complete.
Since the autumn of 1807, the fits having become more violent, and :he above-mentioned remedies proving ineffeCtual, in February, 180S, an English physician (Dr. Leyghton) Was called in.
-^ Upon examining the patient very minutely, he felt a considerable beating in the epigastric region, and pronounced that the chief seat oft ho disorder was-in the organs of digestion, to which the remedy's must be directed, ami affirmed that when these Mere restored to a healthy condition, the nervous affection would cease. The formerstimuhiting remedies vvere in consequence discontinued ; he adopted the purgative plan which had been proscribed, and with this view directed a table-spoonful of castor-oil to be taken,every evening. Just as the patient commenced this treatment, he was seized, with great debility, which obliged him to use crutches or a stick tor three days; hewas not, however, disconcerted, but s'tid he felt as if he should not. have a fit This was the ease, the fit, which had regularly occurred every day lor three months and a half, missed that day, but returned on the following day, and became tertian. The paroxysms continued about tour hours, violent on the onset and termination, but milder in the .middle, though severe pains in the head were experienced through? put. The castor-oil', which was regularly given ^very evening for twenty days, occasioned in about half an hour, a co-' pious evacuation of fceces of very bad appearance, some of .them being hard, and long retained ; others more recent, but Jll digested, the urine was thick. These circumstances induced tl^e physician to visit his patient during a paroxysnl.
On the 25th of February, three days after having commenced the remedy, l)r. L. accordingly saw the young gentleman, towards the end of a fit. He spoke little, knew what he said, and recognized the persons around him, and his signs indicated severe pains in the head. Dr. L. continued the castoroil, and directed some pills with aloes, calomel, soap, and ginger; three of them, and afterwards four were taken an hour before supper, and the oil was given when goingto bed. A strict regimen was enjoined, in which weie excluded, Coffee, beans, peas, spinach, &c. and purslain which was always found badly digested. The treatment being continued, the digestive power improved, the beating, which had been felt in the epigastrium, gradually diminished, and the pulse became less nervous.! At length, in March, 1K)8, the fit which was expected tit nine in the morning did not occur, and lias not returned since. The medicines, h-nvever, yu rr < ttinued as usual for six days longer, when the quantity was di- ?1S8 Critical Analysis. minisned, the pills were discontinued altogether on tlie 19th of April; but an aperient mixture was still taken to keep the bowels open. Alter forty days of convalescence, he was allowed to go on board ship, with proper precautions respecting bis diet. In a former nnmber of this Journal we gave an extract from this Pamphlet, sufficiently indicative of its character, and containing, as we conceived, results of considerable interest, deduced from extensive experience, and calculated to illustrate the natural history, and prophylactic properties of Vaccina. As the result of observations, apparently given without partiality or prejudice, wo cannot but recommend it to the notice of the Profession. The following " Directions for the Vaccine Inoculationwe think maybe generally useful; " 1. The limpid matter'should be taken from a decidedly characterized cow.pock, which is proceeding, apparently, through its respective stages. It is most efficacious in producing the vaccina from a pock before the eighth or ninth day ; but is most abundant, and is usually taken, about the ninth day.
It may be used at any earlier period, even as early as the fifth day, if it can be collected. However, matter from a pock later than the eleventh or twelfth days is not more liable to produce inflamed arms than that from younger pocks; and if the cow-pock be excited at all, it is as distinct as from any earlier matter. No differences in the'effects of the vaccine-matter inoculated appear to depend on the presence, extent, or absence of the red areqla. " 2. The matter is usually taken on glass, thread, or a quill, on which it should be buffered to become dry without applying heat ; and when so dried it is scarce visible. The matter may be kept fluid between two glass plates, in one of.which a small cavity has been drilled, or in a bottle filled with hydrogen gas.
i( 3. To produce more effectually the insusceptibility intended ; ? and as dried matter fails much more frequently to excite the vaccina than recent fluid'matter, it will be adviseable, that, instead of a single puncture or scratch, there be matter inserted in two or even three punctured or scratched parts in each arm. If the constitution be affected, one pock is as effectual in producing the unsusceptibility required, as any greater number ; but the chance of the constitution being affected, seems tu be greater from several, than from a single Report of the Broad Street Vaccine Institution. 489 pock. The dried matter at the time of inoculation should be softened by warm, but not very hot water. " 4. The inoculation must be performed in the same manner as for the small pox. " 5. If the infectious matter produce the required effect in three, four, or five days, there will be seen a red spot like a small gn it bite?in six or seven days, a small vesicle will appear?in nine days, ,a circular vesicle (improperly called a pustule) will be found as !arge as a pea, or from ab .hit two-tenths to four-tenths of an inch diameter, usually^ surrounded by a red areola.?By the eleventh day, the vesicle begins to scab or grow dry, and turn black in the middle, and the areola becomes more extensile.?By the fifteenth day, but often later, the pock becomes a mere scab, circular!! prominent, well defined, of a blackish or mahogany colour, adhering firmly ; but the areola disappears. Unless it be separated by violence, the Scab does not fall off, in general, sooner than the twentieth day. It then leaves a cicatrix permanent for life. " (>. If the eruption or pimple, excited by inoculation, has not the characters and does not pass through the stages in the course above stated (5), although sometimes anomalous, this cow-pock may render the constitution unsusceptible of the small-pox, yet it cannot be depended upon. In such cases the inoculation should be re-instituted ; for if the vaccina cannot be again excited, the unsusceptibility desired will have been produced ; but if a further proof be wanted, recourse must be had to inoculation with the variolous matter. " 7. In many cases, no constitutional affection or fever can be perceived: when it occurs, it is aimost always on the^ ninth and tenth days; but provided the pock exhibit the distinctive characters of the cow.pock, even without areola, with the usual course of its stages, the susceptibility of the small-pox will be generally as effectually destroyed, as if there had been considerable febrile affection, and an extensive areola. " S. Experience having at length shewn that persons who have gone through the vaccina with ail the known appearances of the most effectual sort, are susceptible of the small .pox, although in the proportion of at the most, one out of 500, it is advisable to reinoculate either cow-pock or variolous matter in a few months after the first inoculation* " 9. If erythema, like erysipelas, extend over the arm with swelling, pain, &c. it has always subsided in a few days'of itself, only avoiding irritating applications, or at most on using sedatives. " io. Eruptions sometimes occur, but they require no particular treatment.
"11. The small-pox may break out at any period within twelve days of inoculation for the cow-pock. If they appear earlier than the sixih or seventh, the vaccina is cut off in its progress; if they appear later, the vaccine-pock goes'forward in its usual course. " 12. The medical treatment which may, be required from un-3 S 2 usual V ? 490 Critical Analysis. usual or supervening complaints, is similar to that in the smallpox. ' " 13, Measles, chicken-pox, hooping-cough, and other disorders may intervene during the vaccina, without, irw.general, varying its progress.
The Edinburgh Medical and Surgical Journal, No. XX\ II.
Case of Asthma, cured by'Stramonium.?Continued iroin Page 244.?Mr. English, a medical practitioner, here ?el tes his own'case. In very early life, when a boy^, he was subject to wheazing and shortness of breath upon any slight eold. "When in China, in 1799, he was seized with a severe paroxysm of spasmodic asthma, accompanied with hepatitis. The paroxysms of asthma have since had frequent returns.
" The paroxysm commences with the usual symptoms of cold, together with purging and much evacuation of urirte, succeeded by intolerable flatus in the stomach and bowels, frequent convulsive cough, constant wheezing, with painful dyspnsea, being unable to till the chest with air: any sudden exertion, speaking above a word or two together, or attempting to walk up a hill or up stairs bring on suffocation ; much frothy tenacious saliva is discharged from the throat, with some congealed phlegm from the bronchia, and in the mornings, what is expectorated is often streaked with blood, and sometimes a little pure blood . is coughed up The paroxysm runs its course in from three to five days, when the flatus subsides, and expectoration becomes free and easy; being, instead of frothy or tenacious snhva, and the jelly or white of egglike substance, coilimon phlegm, with a little good looking pus." Here is jumbled together a.collection of very formidable symptoms, and had we not been assured, by persons who seem to have the means of knowing, we should doubt their being related by a person e<3jicated in the medical profession.
Who would expect to hear a surgeon say that 4i instead of frothy tenacious saliva, and the jeily or white of egg-like substance, common phlegm, with a little good looking pus," "wereexpectorated. Notwithstanding we find catharsis, dyspnoea, submurias hydrarg. &c, &c. in (his production, "\ve still doubt its being written by, a surgeon, because we have never met with a person actually of that profession, who Coulcl say that u frothy tenacious saliva" was at any time expectorated. from the bronchia. The unadulterated herb was smol&d the cure is stated to have been rapid, and permanent.
As we have no doubt of the power of Datura stramonium over certain cases or states of difficult respiration, we are concerned to see any equivocal histories of its effects laid before the public. Notes on Diabetes MeUitus, as it odours in Ceylon. By Thomas CiiuisTtt, M. D.?These notes were written at Columbo in Ceylon, in September, lf*09 : they contain a "detail of several ca^es of diabetes, all of which were either relieved or cured by pursuing the method suggested by Dr. Hollo. The disease subsided in proportion to the-strictness willrwhich the patient adhered to the use of animal food.* It appears, from these notes, that diabetes mcllitus is of more frequent occurrence in Ceylon, than on the continent of India, or in Europe. The fact of tFie frequent occurrence of diabetes among the Cingalese is endeavoured to be accounted for from the diet of these people.
-The bulk of the people, in the viciwity of Columbo, consume, I believe, less animal food than in most parts of india, and certainly far less grain, which, from the nature of the soil, and the state of cultivation round Columbo, is not produeed in nearly sufficient quantity for the subsistence of the people. A considerable qua tity of nee is imported from Bengal, and other parts of India, but the poorer orders have seldom 'the means of procuring much rice, and live a great deal upon yams and sweet potati es, jack-fiuit, plantains, or bananas, and particularly cocoanuts, which form a great part of the subsistence of the people in the ?corles, or districts, dependant oriVColumbo. These all furnish sugar ready formed, and in greater abundance than rice, besides which they use a great deal of country sugar or jaggery, prepared from the toddy of the rittiel palm (caryota urens), which is very cheap, and forms an article of export from this place. " As-' a strong corroboration of my opinion, that it is owing to the immoderate use -of these articles, \hat the Cingalese are so subject to diabetes, it ought to be mentioned, that during nine years, in which I have received the hospital returns of all the European and native troops on Ceylon, not a single case of diabetes has occurred amongst them, although the number of men has in general been about 7000, and that of sick has been on an average upwards of 500. The Europeans have beef served out to them daily, and-the natives receive a liberal allowance of rice, on which they chiefly live. ** if it should be allowed, that the natives of .Ceylon are more exposed to attacks of diabetes in consequence of their using little animal food, and subsisting chiefly on articles furnishing a great deal of Sugar, it will readily be understood, on the general principle, that" the " system is acted on most powerful1}7 by those causes to which it is * There is a remarkable fact in the history of medicine connected With one of these patients, Don Juan Appoo, a Cingalese physician. I he practice of this person-used to be principally among small-pox patients, but of which he had not seen a case for the last three years, and is now obliged to keep a school as a means of subsistence. This strongly corroborates the accounts of the extirpation of the small-pox ln the island of Ceylon, by the introduction of vaccination. I 492 Critical Analysis. least accusiomed; that the abstraction of all articles of diet which contain sugar, or from which it is likely to be formed, with the substitution of an animal regimen, will be more likely to produce an immediate change on the state of the urine ar.d digestive powers, than with Europeans who have been accustomed to a more considerable proportion of animal food in their ordinary diet. " Few of the people of Ceylon, who are plain and simple in their general mode of life, are ever disposed to indulge much in the luxury of the table ; so that unless it interferes with tjieir religious principles, or with the state of their circumstances, a change of diet is with them a subject of little consideration; and on that account I have found less difficulty in prevailing on them to comply strictly with my injunctions, which in general went to the entire prohibition of'every thing but animal food of different kinds, dressed with ghee, or clarified butter, and water, with or without the addition of a little brandy.
" It ought to be remarked, that in all my patients there was an increased appetite. Had they been in that advanced stage of diabetes in which the appetite fails, it might have been dangerous to abstract so suddenly all their accustomed articles of food, and advisable only to .adopt the animal regimen gradually or partially." The following extract, translated from the Yoga Ratnulh e, the name of a collcction of prescriptions in (he Cingalese language, will, at least, gratify curiosity. The Pra mehe, or diseased flow of urine, is divided into twenty species, of which ten proceed from phlegm, and are easily cured ; six from bile, which may also be cured with care : nnd four from wind, which last are incurable. In this language diabetes mellitus is called madu melie, honey urine. " The ten species proceeding from phlegm are, " 1st, Udaka mehe.?Udaka in Sanscrit and Pali signifies water, and the symptom; are a flow of very clear urine, cold, without smell, like water, and discharged without pain, with a little slime. " 2d, Ikshu mehe.?Ikshu Sanscrit and utchu Pali, means the juice of the sugar cane, and the symptoms are slimy cold urine, like that Juice-.* . j " 3d, Sura mehe.?Sura in Sanscrit and Pali signifies toddy, and in this the urine resembles toddy, and on being kept deposits a similar sediment. " 4th, Sandra mehe.?Sandra in Sanscrit signifies thickness, and in it the urine, after being allowed to stand a night, is thick. " 5ih, Pishta mehe.?Pislila Sanscrit, fiitha Pali, signifies flour, and in this species the urine, after standing a night, deposits a sediment white as flour, and of very little weight. Another symptom is that, when the urine is passed, the hair of the body stands on end from pain. " 6th. Sukra meh6.?Suira Sanscrit, sula Pali, signifies Semen, and in this the urine is discharged with a mixture of semen, which it resembles in colour. " 7thy Saikta mehd.?Saikta Sanscrit, sikata Pali, signifies sand, and in this Notes on Diabetes Melhtus. 493 this species small round particles of phlegm are discharged with the urine, resembling sand. " 8th.?Sita mehe.?Slta in Sanscrit, Pali, and Cingalese, signifies cold, and the symptoms of this species are extremely cold and very sweet urine. 1 " 9//i, Samairinia mehe.?Samairima in Sanscrit signifies drop by drop, and the symptom is the uriiie being passed drop by drop.
'? 10 th, A1 la mehe.?Anda Sanscrit, lala Pali, signifiesSaliva, and the symptoms are urine mixed v.ith particles of phlegm, in the shape of small threads, and slimy like saliva " The six species proceeding from bile are, " 1j/, Manjesta mehe.;?Manjesta Sanscrit, manptta Pali, is the name of a red seed, and the urine in this species is of a reddish colour, and has a fishy smell. " Id, Rakta mehe.?Rackta Sanscrit, ratlin Pali, signifies blood, and the urine in this species is of the colour of blood, ftels hot/ tastes salt, and has a fishy smell. * " 3d, Nila mehe.?N'da in Sanscrit and Pali, signifies blue, and in this species the urine is of a bluish colour. " 4-th, Hariddra mehe!?Hariddry Sanscrit, halilddy Pali, signifies yellow, and in this species the urine is of a yellow colour, of a sharp taste, and discharged with heat. " 5th, Rala mehe.?Rala in Sanscrit and Pali signifies black, and the urine in this species is of a sooty colour. " Qth, Kshura mehe.?Kshara Sanscrit, hara Pali, signifies saltish, and in this species the urine is to the smell, taste, and touch, like seawater. " The four species proceeding fiom wind are, ^ " lrf, Wasa mehe.?JVasa in Sanscrit and Pali signifies fat, and in this species the urine is discharged frequently, either mixed with fat, or entirely composed of an unctuous substano^. " 2d, Mudja mehe.?Mudja Sanserif mitja Pali, signifies marrow, and in this species the urine is discharged frequently, and resembles marrow, or i3 mixed with that,substance. " 3d, Hasta mehe.?Hast a Sanscrit, hutty Pali, signifies elephant. * The urine in this species' is discharged frequently, and \yiih difficulty, resembling the semen cf a ruttish elephant, or the liquor of the joints. " 4th, Madu mehe.?Madu in Sanscrit and Pali, signifies honey, and in this last species the urine is of the colour and taste of honey. " In the Buynjjn Matjussy, or Medicine Chest, another work, more lately translated from the Pali, the same account is given of the different species of mehe, and it is said they are occasioned, amongst other causes, by whatever produces much fat, urine or phlegm, as indolence, eating cold and sweet things, and food of a watery nature. The "more immediate causes of the madu mehe, are either decrease of the substance of the body, and excess of wind, or the wind's being obstructed and mixed ?with the blood, on which account it is incurable. The distinguishing symptoms of the four species cf mehe proceeding from wind, are flatulence and eructation, tightness of the chest, tremor, pains, restlessness, emaciation, and difficulty of breathing. \ 49i' Critical Analysts. u The only remedy recommended for madu mehc, i* pills composed e? seventeen ingredients, amongst which are the following; Sulphur, nitre, borax, sal ammoniac, yellow arsenic, cinnabar, capsicum, black pepper, and several other vegetables with which I am unacquainted. ?" Although the above division and distinctions of the fira mehe, which seems to include all the diseases of the urine, is arbitrary, and often fanciful; vet it i-< a curious circumstance, that the Indian physicians should have described so distinctly the sweetness of the urine in madu mehe, which had escaped the observation of both the ancient, and modern physicians of Europe till the time of Willis." Case of Tic Douloureux, cured hy Arsenic; by Mr. M'Kuchnie, Surgeon.?Tins case of Tic Douloureux was in a nrtau bl years of age, of a healthy constitution. Various methods were resorted to for the removal of this painful affection. Blistering, mercury to salivation, cicuta, topical bleeding by leeches, were till found ineffectual. In the attack which occasioned the relator to be consulted, the pains were most troublesome by day, seldom disturbing the patient in the night. " Excruciating paroxysms were excited by the slightest irritation ; as by a breath of cold air blowing upon the face ; by attempting to chew, or by speaking nbruptly, and sometimes even without provocation-At these times the pain suddenly darted into the lower jaw, and from that into the cheek, and beneath the ear. Each exacerbation consisted of a great number of short paroxysms, which lasted about a minute, then remitted, returning immediately, again remitted, and $o alternately, generally for about the space of an hour./ The exacerbations were not constant in degree or duration. They sometimes caused violent contortions or the face, most ease being found by twisting the mouth to the left side, <o as to stretch the muscles of the affected places, and by rubbing the skin towards his mouth with his fingers ; relief was sometimes procured by ^pressing firmly over the infra-maxillary foramen. When the anguish was greatest, the face flushed, and tears gushed from the eyes, but no change in the appearance of the parts affected could tc discovered. The patient described the pain to be at one time, as if some-, thing was piercing or screwing into the flesh ; at another, as if it was tearing or twisting from the bone. When the paroxysms ceased, he had perfect mmunity from pain, till the morbid action was again excited. The general health was not impaired; the p'ulse was of the usual standard; the appetite was good ; the bowels were regular." Under the above circumstances the patient took the Solut. Arser?.
As tlie maximum dose of the remedy was approached to, the symptoms gradually subsided, and at length entirely subsided, and a permanent cure! was effected.
Case of Tumours of the Tongue cured by Mercury.?A woman 4? years of age, the mother of a numerous family, and still menstruating regularly, but whose health had suf-, ~ fered Observations on Herpes of the Prepuce. 495 fcred from abortions arid floodiugs, about two years and a halt before the time here spoken of, was attacked with great pain in the tongue, which swelled'to such a pagnitude that she could not spe;tk, or swallow any tiling but Hnidsl This swelling subsided in six weeks, but left several small krtots in tue substance of the tongue, round the edge of its anterior porlion. These tumours were irregular in their surface, haying various depressions and elevations, and were as hard and Unyielding as scirrhus. They were all painful; and the sensation they gave was as if a spear was thrust from them into the inferior jaw. By the use of the blue pill,-and frictions, so as to produce considerable ptyalism, these tumours were completely removed. v Case of Recovery from an excessive dose of Laudanum.?? A woman 28 years of age swallowed an ounce of T. opii. The symptoms were alarming, but by the use of emetics and cathartics they were removed; and the patient recovered.
Observations upon Herpes of the Prepuce.?The disease,, of which some cases are here given with remarks, was first noticed in this Journal, (vid. Med. and Phys. Journal, 'Vol'. 23. p. 411,No. 13b,.for June, 1810), where a history of its appearances and progress was given, with a plate shewing the changes from day to day. Before the account there given, we believe no writer had mentioned this complaint; neither does it appear, prior to that publication, to have been understood by prncthioncrs, but was often treated for syphilitic chancre, with consequences hazardous, injurious, and sometimes fatal. In the paper in the Med. and Phys. Journ. above cited, it was denominated an Acute Eruptive Disease of the Integuments of the Penis a term which seems clearly to characterize its appearance, symptoms, and pro-> gress.
About a year after the publication of this paper in the Med. and Phys. Journ. a writer who is a reporter from the Carey-Street Dispensary for the,Edinburgh Journal, noticed this disease under the term Herpes Preputialis. When speaking of it, he observes, " I know of no writer who has mentioned the herpes of the prepuce, except one, in a Number of the Med. and Phys. Journal for June, 1810, who has given a plate verty ill representing its form." As we admit the reporter to be a person of considerable research in' medical literature and the history of diseases, we consider the first part of the sentence above quoted very strongly to establish the claims of the writer of the paper on an " Acute eruptive Disease on the Integuments of the Penisin the Med. and Phys. Journal for J une, 1810,. to priority of description. plate annexed to tlie paper in tin; Med. and Phys, Journal, but ill represents l!:e fbrm of this disease, Ave must be allowed to say, probably v. as suggested by the reporter's never having seen the disease in the form which it appeared to the writer of the paper. Perhaps he had then only seen the disease as it occurs within the fold of the prepuce, and where both the vesicles and subsequent ulcers are placed in contact with the glans, as the/prepuce is brought forward. Undef that circumstance of locality, the plate does but ill represent' the form of the disease ; neither was it ever intended to represent the disease so placed. We are-the more confirmed that the reporter has taken his idea of tlie disease from eases where the vesicles have been placed within the fold of tlie prepuce, by his speaking1 of its going through ijs stages in fourteen > days; whereas, when the vesicles are placed on the tegument of the body of the penis, a very frequent occurrence, it goes through its stages, and is completely well, in ten days at serration |Kls gone, and a great number of cases have fallen Within our practice, we have seen it five times in seven situated on a part of the integument of the penis which is not prepuce. -? ; The cases before us add sometliirig to the history of this disease, though our experience has not taught us that it is to ke repelled or shortened in ics duration by art, as the writer of these observation,s asserts. YVe believe that the interference of the surgeon may prolong but not shorten its duration: we know no instance in which it has been repelled, nor are we in the Jcast aware of any, prophylactic process which should prevent its recurrence; for when it has once happened it returns again am} again, at intervals of a few weeks. The profession is indebted to Mr. M'Kechnie for again bringing the subject forward, and inducing the surgeon to attend to the history of a disease which has confused and misled the most experi- M'Keur, Surgeon.?We transcribe the minutes of this case chiefly with a view to shew the curious fact as before1 asserted by Mr. Watt, of the blood getting a firmer texture, and assuming the inflammatory appearance, as bleeding was persisted in. \ November 16th.?Pulse 100, so feeble as to be with difficulty numbered; much oppression in the chest. 5viii. of blood were taken from his arm, being all that could be procured; veins so relaxed and empty that it is with difficulty any of them can be opened; pulse not altered by the bleeding, but feels a good deal relieved in the chest ; laxatiye pills jiro re nata. " 17th.? Pulse scarcely to be felt; veins cannot be made tense by ligature 3 viii. of blood again procured with much difficulty: the ' 'energy of the heart seems almost gone ; no alteration from the bleeding ; the blood taken yesterday covered with a thin blue film; the substance of it very loose, and black in the bottom ; serum exceedingly white; a large blister to be applied over bqth kidneys.
" 18///. ? Blister rose well, but discharges little; other symptoms as before. Urine about xxlb. in the 24? hours; =x. of blood again taken; no sensible effect from it; blood taken yesterday of the same appearance *s before.
" 19/h.?Pulse 104-, more regular, and somewhat fullerblister now , runs well; =xii. of blood taken now for the first tjnje it runs in a full stream ; felt relief while flowing ; pulse rather improved by bleed-*ng-? 23/7, Blood taken yesterday firmer in texture than any formerly, ' and contracts more on the surface, with a thicker buffy covering ; pulse 3 T 2 as 498 Critical Analysis. as yesterday; ?xii. of blood again taken ; veins now fill better, and the blood flows more forcibly. " 21 st.?Pulse about 100, considerably firmer; gxvi. of blood taken ; much relief while flowing; pulse not altered ; lime-water ordered. / " 2Id.?Pulse 120, but quite distinct, feels very languid; palpitation very distressing; considerable oppression about the prcecordia : on the jvhole very unwell; drink and urine considerably diminished'; blood taken yesterday can be suspended on a probe ; feels most comfortable in bed, and cannot walk withput difficulty ; stools for the last two days rather brown, and without any blood ; tongue a litrle cleaner ; mouth still very bad tasted. Ordered powders of ipecacuanha and oxyd antimon. c. phosphat. calcis. " 23d.?Sweated some through the night; feels to-day easier; pulse as before;" ?x. of blood again taken in a very full stream, and with great force ; pulse sensibly weakened by it ; otherwise it was intended to have taken a much larger quantity ; much relieved while flowing; never any tendency to syncope. " 24//;.?Thirst lessened, in other respects as before ; ?xv. of blood taken ; flowed with great force as in pneumonia; pulse before bleeding 108, after it 110, and much weakened ; blister to be repeated. " 25th.?Blister discharges freely; serum of the blood taken yesterday of the appcarance of the matter of a scrofulous abscess, crassamentum has the tenacity of healthy blood ; considerable butty coat; has much less thirst, and voids about one-third less urine than before; thinks, his mouth not. quite so bad tasted as before;, has sweated a good deal; skin softer and more natural ; urine not quite so^ awe.et. " 2Qth.?In the morning while in bed, pulse 104', after being up 120, tolerably firm ; rather more thirst to day ; urine not increased; ?,x. blood taken, flowed more feebly; bowels regular; stools brown; , sleeps tolerably. " On the 28th, gxii. of blofld taken ; on,the 29th a similar quantity. No material circumstance occurred till December 1st, when a violent diarrhoea came on, with severe griping ; drunk little since it came on ; urine diminished to one half; pulse 100, and firm ; little appetite; feels very languid; -tools still brown. " December 2d.?Diarrhoea continues; stools very dark brown, very languid ; griping very severe; pulse 100, tolerably firm ; urine for these last two days not above ii lb.;' thirst also greatly diminished. " 3d.?Diarrhoea diminished ; urine increased <o the same quantity as before the diarrhoea, but drinks less; pulse as yesterday. Pills of Calomel and ipecacuanha ordered. " 4//;.?gxii. of blood taken ; pulse weakened by it; in other respects as before.
By ibis process the diabetic symptoms were relieved, but tlie patient did not recover his health, "Was the first person that I had seen taking it. He had been troubled with gout at various periods during thirty years, of which disease distorted joints bore the most ample testimony ; independently, however, of these appearances, his body exhibited no mark of disorder, and for his time of life might be considered healthy and stiong. The attack oi gout in which he began with the eau medicinale was exceedingly severe, and pretty general, attacking ancles, knees and elbows, [n this state, with much avidity he took half a bottle of this medicine; but not finding any amendment from this dose, after an interval of six hours, he had recourse to the remaining portion. This, however, soon began to have effect, and operated m6st powerfully by all the secretions, occasioning a* the same time violent vomiting", purging, sweating, and acting no less violently by the kidnies. These powerful effects continued without ' * intermission for at least forty-eight hours, when the patient became exhausted to the very last extremity, and at the time my interference Was requested, appeared almost lifeless ; body motionless, and covered with a cold moisture ; voice nearly inaudible, and the powers of perception scarcely remaining. Nothing for some time could appear more unpromising. By diligent and unremitting attention, however, with the aid of.warm Madeira and cordials, the exhausted powers were supported, and at length raised1; but the patient long remained in a state of considerable weakness, and his convalescence was for some time doubtful. jg unnecessary for me to say, that this fit of ^out was completely removed by this violent process,?a cure which almost cost the patient his life. In one particular, perhaps, the patient erred, and that was by dicing second dose too soQn alter the first? The peiiod between each 500 Critical Analysis. each may be thought should have been longer than six hours ; but it should be remembered, that the pamphlet published on its merits states, that some persons take a whole bottle at a time ;?how then are the public to discriminate when they should take a larger or a smaller quantity ? The baronet certainly had some prudence in the matter ; for lie did not takethe remaining half bottle, until a lapse of six hours had given him every reason to suppose that it would produce no effect.. he unfortunately taken the contents of a whole phial in the first instance, there is every reason to suppose that he never would have recovered the shock. I have stated so much to shew, that the medicine is very powerful, and that great care and attention is_nece;sary in-the use of it, and that patients disposed to try it should, in the beginning, measure tl\cir way very carefully." Mr. Barry, ;i respectable watchmaker at Clifton, here relates his own case. ' " About the middle of January, 1811, I was threatened with symptoms which generallyportend a regular fit of gout; its violence, however, did not, as on most preceding occasions, increase in any particular part, so as to deprive me of rest, or cause actual confinement, tili about the 23d, when the attacks in the stomach becoming much more frequent and formidable, 1 determined on taking the celebrated eau medicin;ile, two bottles of which I had long kept by me for that purpose. I began with half a bottle, which for two hours seemed to produce little or nfi effect. I then felt considerable pain in the head, whether of real gout, or the effect of the medicine, I cannot say : this was soon succeeded by 'delirium, afterwards a great nausea in the stomach, purging, and sickness, but not the smallest disposition to perspire. This continued eight or ten hours, when I began to expect the wished-for relief, of, which I had so long and so confidently flattered myself the medicine would af? ' ford me; but, alas ! I found the disorder increasing, both as to extent and virulence, and, after a lapse of four or five days, I took the last half bottle, with, however, no other effect than a nausea of much less duration than the former, still, however, without the wished-for success. Being then apprehensive that I had not taken a sufficient dose, I resolved, after a similar interval, to take the remaining whole bottle at once, which had much the same effect in every particular as the first half bottle, with this difference only, that the sickness was of much longer continuance, but not sufficiently violent to enable me to vomit without great difficulty. The nausea on the stomach remained for several days, and the gout there, as well as in the extremities, evidently gaining upon me, presented ' no other appearance or feeling, than that 1 must shortly sink under it. Much about this time there appeared all over my body an eruption resembling very much the measles; but as I had had that disorder many years before, I concluded it must have been occasioned by the medicine. A few days after this I was seized in bed very suddenly with a copious spitting of blood, attended with a wheezing from the throat, and coughing,'which for a while threatened suffocation; this, it is supposed,must have arisen from the rupture of some vessel about die lungs, by efforts made during the sickness to vomit. **. The hemorrhage continued to return in an alarming degree, at intervals* Howard's Observations Cancer. 501 intervals, for a week or ten days, till, weakened by its fitfquent recur-l^nce, and apprehensive, if longer neglected, it would inevitably lead to c most dang?*eus consequences, I called in two medical gentlemen to Ir>y assistance; by whose skill and attention I was soon restored to a state of rapid recovery.'?Here is a "very clear and able description of a Violent fit of gout, in which the eau medianale had a very fair trial, and V/herein it not only completely failed, but was soon followed by a considerable aggravation of the complaint, and with symptoms threatening